Metabolically healthy obesity: prevalence, phenotype characteristic, effectiveness of weight loss

Abstract

The goal was to study the prevalence of metabolically healthy obesity (MHO), the features of this phenotype compared with metabolically unhealthy obesity (MUHO), and the effect of weight loss on cardiometabolic risk factors in patients with MHO. Material and Methods — To assess the prevalence of MHO, 389 case histories of obese patients aged 18-60 were analyzed. Three types of MHO criteria were used: 1) the definitions of metabolic syndrome (MS) according to International Diabetes Federation (IDF), 2005; 2) the HOMA-IR index (<2.7); 3) Biobank Standardisation and Harmonisation for Research Excellence in the European Union (BioSHaRE-EU) criteria, 2013. The study included comparative analysis of the medical history, anthropometry, basic metabolic parameters, and adipocytokine levels in 44 patients with MHO (taking into account the MS definitions) and 33 women with MUHO initially and with a decrease in body mass (BM) by ≥5% after 6 months. Results — The MHO prevalence was: according to the definitions of MS – 38.6%, according to HOMA-IR index – 34.5%, in BioSHaRE-EU – 9.6%. All indicators of anthropometry, carbohydrate and lipid metabolism, including the HOMA-IR index, interleukin-6, and chemerin, as well as the duration of obesity in the MHO and MUHO groups significantly differed (p<0.05). After 6 months, MHO-patients who lost ≥5% BM from the initial value (63.6%) showed an increase of adiponectin, a decrease in waist circumference, HOMA-IR index, C-reactive protein (CRP), retinol-binding protein 4 (RBP-4), and chemerin (p<0.05). Conclusion — The MHO prevalence was maximal according to the MS definitions and minimal with BioSHaRE-EU criteria. The BM decrease in MHO is accompanied by a decrease in the content of proinflammatory adipocytokines and the HOMA-IR index, which determines the need to treat obesity regardless of the phenotype.